Provider Demographics
NPI:1982014064
Name:MAYFAIR ADVANTAGE MRI, INC
Entity Type:Organization
Organization Name:MAYFAIR ADVANTAGE MRI, INC
Other - Org Name:ADVANTAGE IMAGING OF CHICAGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:NELLAMATTATHIL
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R) (CT)(MR)
Authorized Official - Phone:847-533-9029
Mailing Address - Street 1:4351 N CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1502
Mailing Address - Country:US
Mailing Address - Phone:773-427-1222
Mailing Address - Fax:773-427-1333
Practice Address - Street 1:4351 N CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1502
Practice Address - Country:US
Practice Address - Phone:773-427-1222
Practice Address - Fax:773-427-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)